1 / 32

Pt. 2: Frustrated with Obesity Management? 5210 & Motivational Interviewing to the Rescue!

Pt. 2: Frustrated with Obesity Management? 5210 & Motivational Interviewing to the Rescue!. Jamie Jeffrey, MD, FAAP Medical Director, Children’s Medicine Center & HealthyKids Pediatric Weight Management Program Clinical Associate Professor, WVU-Charleston

izzy
Download Presentation

Pt. 2: Frustrated with Obesity Management? 5210 & Motivational Interviewing to the Rescue!

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Pt. 2: Frustrated with Obesity Management?5210 & Motivational Interviewing to the Rescue! Jamie Jeffrey, MD, FAAP Medical Director, Children’s Medicine Center & HealthyKids Pediatric Weight Management Program Clinical Associate Professor, WVU-Charleston Project Director, KEYS 4 HealthyKids

  2. The 15 minute Obesity Prevention Protocol • Step 1-Assessment • Step 2-Agenda Setting • Step 3-Assess motivation • Step 4-Sumarize and clarify Goal easy…………………………..

  3. Frustrated?

  4. Obese

  5. STAGE 1-PREVENTION PLUS • Dietary Habits & Physical Activity • Review 5 2 1 0 • Behavioral Counseling • Eating breakfast daily • Limiting meals outside the home • Family meals 5-6 times a week • Allow child to self regulate at meals without overly restrictive behavior .

  6. STAGE 1-PREVENTION PLUS • Goal • Weight maintenance with growth resulting in decreased BMI • Monthy Follow-up • After 3-6 months, no BMI change, advance to stage 2 Tx

  7. Stage 2: STRUCTURED WEIGHT MANAGEMENT • Dietary Habits and Physical Activity • Plan for balanced diet, emphasizing low amounts of energy dense foods. • Increased structured daily meals and snacks • Supervised active play at least 60 min/day • Screen time 1 hour or less a day • Increased monitoring by provider, patient and/or family

  8. Stage 2: STRUCTURED WEIGHT MANAGEMENT • Goal: • Weight Maintenance with decreasing BMI • Weight loss not to exceed 1 lb/mo in ages 2-12 • Average weight loss of 2 lb/week in older children and adolescents • Monthly Follow-up • If no BMI improvement, advance Stage 3

  9. Motivational Interviewing A directive, person-centered counseling style for increasing self-determination by helping people explore and resolve ambivalence-Miller & Rollnick, 2002

  10. MOTIVATIONAL INTERVIEWING Patient centered care approach Nonjudgmental, empathetic and encouraging Behavior change influenced more by motivation than by information. Core principle: People are more likely to accept and act on opinions that they voice themselves.

  11. MOTIVATIONAL INTERVIEWING-”OARS” O = Open ended questions (start with asking permission) A= Affirmation R = Reflective Listening (Repeat and summarize) S= Summarize

  12. MI…..Step 1 ASK Permission

  13. MI: OPEN THE ENCOUNTER • Ask permission: Would you be willing to spend a few minutes talking about Suzy’s weight? Are you interested in ways to stay healthy? • Ask open ended question – Listen – Summarize • What do you think? How do you feel about your weight & health? What have you tried so far to work towards a healthier lifestyle?

  14. Good ? or NOT • What do you think keeps you from getting to class on time? • Why don’t you try eating more veggies? • Why would you want to study anyhow? • What’s wrong with just trying a few days without coke? • What would be better for you if you lost weight?

  15. MI Continued • Share BMI/Weight Information • Your current weight puts you at risk for developing heart disease and diabetes. Your BMI is 95ndpercentile and show on colored chart • Ask for patient’s interpretation, what do you make of this? • Add your own interpretation/advice as needed after eliciting the response of the patient/parent.

  16. “WORDS” of Advice “I” and “Y” Words I think you should…. You should…. Directive You should I want you to try…. • Neutral Language…. • Other pts have found that… • Others have benefited from… • I had one pt that… • Conditional Words • Might consider • Maybe you can try

  17. Use “wiggle” words • Perhaps • Maybe • If you don’t mind • One option is • You might consider • Here’s a thought • What do you think

  18. Importance/Confidence Ruler Willingness/ Importance ? On a scale of 0—10, how willing/important is it to you to make a change toward a healthier lifestyle? 0—–—1—–—2—–—3—–—4—–—5—–—6—–—7—–—8—–—9—–—10 Not Important Somewhat Very Important Confidence? On a scale of 0—10, how confident are you that you can succeed? 0—–—1—–—2—–—3—–—4—–—5—–—6—–—7—–—8—–—9—–—10 Not Confident Somewhat Very Confident

  19. MI: NEGOTIATE THE AGENDA Some ideas for staying healthy include… What are your ideas for working toward a healthy weight? Introduce 5 2 1 0 and ask if the patient is interested in discussing one of these further, ask if they have other ideas.

  20. MI: ASSESS READINESS &TAILOR THE INTERVENTION

  21. EXPLORE AMBIVALENCE • Step 1: Ask a pair of questions to help patient explore the pros and cons. • What are the advantages of keeping things the same? AND What are the advantages of making a change? What would be better for you if…..

  22. EXPLOREAMBIVALENCE • Step 2: Summarize ambivalence • Let me see if I understand what you’ve told me so far… (start with reasons for maintaining status quo end with reasons to make a change)

  23. CLOSE THE ENCOUNTER • Summarize: Let’s review what you have worked on today • Show appreciation for willingness to discuss change. • Offer advise, emphasize choices, express confidence • Confirm next steps and schedule F/U.

  24. Brave Volunteer?

  25. The 15 minute Obesity Prevention Protocol • Step 1-Assessment • BMI • Ask permission to discuss weight • Elicit parents concern • Reflect/Probe • 5210 Questionnaire (Short vs Long) • Reflect/Probe Cycle

  26. The 15 minute Obesity Prevention Protocol • Step 2- Agenda Setting • Target behavior willing to change • 5210 with Goal • Goal Trackers

  27. The 15 minuteObesity Prevention Protocol • Step 3-Assess Motivation & Confidence • Ruler • Pocket Guide • Step 4-Summarize & Clarify Goal

  28. The 15 minuteObesity Prevention Protocol • Schedule Follow-up Office Visit • F/U 1-3 months depending on level of commitment • Remember Chronic Care Model

  29. Practice Makes Perfect

  30. Resources • www.aap.org • www.mcph.org/Major_Activities/keepmehealthy.htm • www.letsgo.org • www.nichq.org • www.letsmove.gov

  31. Pediatrician Dietician Psychologist Nurse Educator Exercise Physiologist PAC HealthyKids Team

More Related